Ebola Outbreak: An infectious disease doctor tells his story

Editors Note: Dr. James Wilson, a pediatrician and infectious disease expert with AscelBio is currently traveling to Monrovia, Liberia to help with the humanitarian effort. We had the chance to speak with him before his departure. Please join us as we send him well wishes and prayers for a safe journey and the ability to help others.

The deadliest outbreak of Ebola ever recorded is currently overwhelming West Africa. The Liberian government has closed its borders with only three checkpoints for entry, each set up with containment centers. Since March of this year, there have been 1,201 reported Ebola cases resulting in more than 672 deaths.

We had the opportunity to speak and correspond with Dr. James Wilson, a pediatrician and infectious disease expert with AscelBio and Sermo Infectious Disease Community Correspondent. Dr. Wilson helped to develop a system of bio-surveillance that assists with disease forecasting. He led the creation of the Haiti Epidemic Advisory System (HEAS) after the 2010 earthquake and led ground operations through the ensuing cholera disaster. He has been in constant contact with medical workers in West Africa since the latest outbreak.

What is Ebola?

Ebola is a cluster of five different strains with varying levels of mortality.

1. Bundibugyo Ebola virus (BDBV)

2. Zaire Ebola virus (EBOV)

3. Reston Ebola virus (RESTV)

4. Sudan Ebola virus (SUDV)

5. Taï Forest Ebola virus (TAFV)

Of the five, three were connected to past outbreaks in Africa. The current Ebola pathogen is EBOV – the deadliest – with a 90 percent mortality rate. Due to early treatment, the current death rate has dropped to approximately 60 percent. While there is no cure for Ebola, immediate medical care increases the likelihood of survival.

The starting symptoms of Ebola are flu-like which progresses quickly to vomiting, diarrhea, organ failure, and internal or external bleeding. The incubation of the virus is between two and twenty-one days resulting in death from major organ failure, loss of blood, or shock. Those who survive can still spread the virus to others for up to seven weeks after recovery.

Containment Issues and the Outbreak Today

In fact, two more staff members at Samaritan’s Purse have been diagnosed with Ebola in the last 24 hours. Wilson writes inside the Sermo community:

The security situation has dramatically deteriorated in the last 24 hours.

Providers in Monrovia believe they are only seeing 25 percent of the actual Ebola cases in the community.

“Folks, this is about as bad as it gets in today’s world.” ~ Wilson

The disease, which broke for the first time in an urban area has quickly spread through Guinea, Liberia, Sierra Leone, and now via air transport to Nigeria. Sanitation, lack of understanding about the disease, and local traditions have created problems for governments and medical aid workers.

Under-educating residents of the deadly impact of this virus has caused mistrust. In Sierra Leone, locals who believed foreign healthcare workers were using Ebola to kill people and steal their body parts attacked a hospital. Police had to use tear gas to fight off the crowd. Some also believe the virus is being carried in by foreign aid workers.

Religious practices have contributed to the spread as families sneak bodies – dead or alive – out of isolation. The deceased are mourned through their religious ritual, which involves close contamination, and the sick are taken to local alternative treatment options.

While the initial spread of the disease was likely through bush meat, such as primate or fruit bats, the majority of the transmissions now are human to human.

The residents of these districts are not the only ones in danger of contracting Ebola. Humanitarian workers are also falling victim. “History has shown that failure to be vigilant, failure to implement and properly execute barrier nursing techniques, and lack of overall experience in medical management have led to healthcare worker infection and death,” says Dr. Wilson.

There are some untested vaccines available, but according to CNN, “It is too late in this outbreak for vaccines to have enough of a preventative impact, but Ebola will emerge again in the future. If safety can be proven, the stockpiling of vaccines could improve the outcome of future outbreaks.”

Ebola Threat in the U.S. and Abroad

The Centers for Disease Control has deployed more members to West Africa for support. Though they will not be interacting with the infected, the goal is to assist in the training and education of those who may have been exposed. Wilson is traveling today to Monrovia today to join the aid effort.

“It’s improbable, but not impossible, that it could reach the U.S.,” says Wilson. “If [Ebola] moves, France will be hit the hardest. Given the number of urban areas with international ports of entry that are involved, the risk for translocation by air flight continues to increase. France is for us what Canada (i.e., Toronto) was for SARS. Meaning we expect to see translocations to France before the U.S., but anything is possible at this point.” According to NPR, about 10 percent of flights leaving from Conakry, Guinea fly to Paris.

Due to better sanitary conditions, superior health care, and cultural factors, if an infected individual made it into an industrialized country, any outbreak would likely be small and easily contained.

What Can U.S. Doctors Do?

The CDC has released a series of preventative alerts and warnings for health workers and travelers. Wilson advises “anyone receiving a patient in an ICU setting suspected to have come from Africa should be vigilant for viral hemorrhagic fever until proven otherwise.”

As the probability of translocation by air flight increases, extra caution and attention are highly recommended within emergency departments, inpatient, and intensive care settings.

As an M.D. or D.O., what are your thoughts about this outbreak? How do you feel about the likelihood that this will travel to the United States? We will be discussing this further inside our community and would like to hear your thoughts.

Clarification: Ebola has “moved” already by air flight to Lagos, Nigeria, and the gentleman, an American citizen, died. We are concerned about France given the cultural and air traffic connectivity. That said, most of the European and African countries are fully aware of the threat and have taken tremendous precautions.

Just today an emergency dept in Charlotte, NC was in lockdown during an eval of a returning traveler suspected to have flown from a high risk area, however this was ruled out. This is precisely what every emergency department in the country should be doing- be vigilant, ask a travel history, and take proper precautions to protect the community. Those physicians should be commended.

FYI:
THERE IS A WAY TO HALT THE PRESENT EBOLA EPIDEMIC !!
RATIONALE:
EBOLA is highly susceptible to UV-C RADIATION; therefore,at the VERY EARLIEST inception of infection and ,hopefully prior to initiation the destructive effects of the EBOLA VP35 on the human immune targets (monocytes,macrophages,interferon,etc.), the virus is vulnerable to sequential destruction by using DIALYSIS MACHINERY and UV-C PULSE RADIATING TUBING!
METHODOLOGY:
Since dialysis tubing is extra corporal it can be surrounded by
UV-C pulse radiating tubes.Virus blood count is obtained prior to exposure; then, following each blood cycle another count is made. IF evidence ANY DECREASE in count then cycling should persist until viral count is ZERO.
NB:
Hypothetically this method should so quickly destroy the EBOLA that it should not have an opportunity to form resistant strains; howener, if this proves successful and, hopefully, there are survivors they must be kept in isolation for a short period to be certain there are NO resistant strains.
Leonard Flom,M.D.
Clin .Asst Prof- Biometric Research
NYU School of Medicine
2013 Inductee ‘INVENTORS HALL OF FAME”(IRIS BIOMETRIC)
1Aug.2014